The 2011 New York Skeletal Biology and Medicine (NYSBM) conference is the fourth international conference in a series of biennial meetings that began in 2005, initially under the joint auspices of the New York Academy of Sciences and Mount Sinai School of Medicine. The target audience for this conference comprises of basic scientists, clinical investigators and clinicians with interests in diverse disciplines of endocrinology, physiology, cell biology, pathology, genetics, molecular biology, rheumatology, radiology, orthopedics and oncology as they relate to bone development, homeostasis and health. The previous conferences have had up to 250 participants, of which up to 85 experts in various areas of basic and clinical bone disease were invited to speak or chair sessions. The past years'meetings have been cherished by the participants and attendees from all parts of the world. Featured amongst other plenary lectures in 2009, were the Diane Wolf Memorial Inaugural Lecture given by Dr. Victor Dzau (Duke University), the 2nd Rosalyn Yalow Lecture given by Sir Michael Berridge (University of Cambridge) and the 2nd Gideon Rodan Memorial Lecture given by Roland Baron (Harvard). The conference now commands the reputation as being a premiere reference meeting in skeletal biology. It provides vital insights into the mechanisms of bone development and restructuring, including cellular and mechanical triggers, receptors and signaling pathways. It also touches upon the significant role that other physiological systems or disease states such as the immune system, inflammation, diabetes, infection and cancer play in musculoskeletal health. Recent findings are also shaping therapeutic directions to focus on multiple modes of intervention involving anti-resorptive and importantly anabolic agents. A better understanding of the fundamentals of skeletal biology, the pathophysiology associated with skeletal disease and the molecular and genetic basis of these disorders is thus likely to impact on our ability to find effective treatments. The 2011 NYSMB will combine basic, clinical and translational research in a forum designed to provide the most current information on aspects of skeletal development and its relationship to bone disease and its treatment.